Resuscitation-Induced Intestinal Edema and Related Dysfunction: State of the Science

Shah, Shinil K.; Uray, Karen; Stewart, Randolph H.; Laine, Glen A.; Cox, Charles S.

doi:10.1016/j.jss.2009.09.010

Cited by 57 publications

(46 citation statements)

References 98 publications

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“…[16] To achieve this goal, HS strategy has been designed as the optimal therapeutic modality to attenuate the postoperative intestine edema after major operation or severe trauma. [17] The present study was conducted to determine if HS intragastric injection would reduce the postoperative intestine edema so as to promote intestinal function recovery in patients undergoing major upper gastrointestinal surgery, which has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

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Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

et al. 2017

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The aim of this study was to explore the impact of 3% hypertonic saline (HS) intragastric administration for patients who underwent upper gastrointestinal surgery.During the postoperative period, 3% HS has been suggested as a means to improve the intestinal edema and reduce gastrointestinal complications.The medical records of 111 patients with HS intragastric administration following upper gastrointestinal surgery and 268 patients, served as control, were reviewed retrospectively. Propensity score matching was performed to adjust for selected baseline variables. Clinical outcomes, including early gastrointestinal function recovery, postoperative complications, and length of hospital stay, were compared according to the HS intragastric administration or not.HS intragastric administration was associated with prompt postoperative gastrointestinal function recovery, including first flatus (risk ratio [RR], 1.32; 95% confidence interval [CI], 0.89–1.65; P = 0.048) and feeding within 3 postoperative days (RR (95% CI), 0.57 (0.49–0.77); P = 0.036). Early ileus occurred in 25 of 108 patients with HS treatment versus 36 of 108 patients without HS treatment (RR (95% CI), 1.43 (0.63–2.15); P = 0.065). The patients with HS experienced a lower overall postoperative complication (odds ratio [OD] 0.57; 95% CI, 0.33–1.09; P = 0.063), including trend toward a decrease for infectious complications (15[13.9] vs 23[21.3]; P = 0.11; OD, 0.59; 95% CI, 0.29–1.22). There was a decreased incidence of anastomotic leakage (1[0.9] vs 7[6.5]; P = 0.033) and postoperative ileuas (5[4.6%] vs 11[10.2%]; P = 0.096) in the HS administration patients.Our study demonstrated beneficial postoperative clinical effects of HS intragastric administration in patients who had undergone upper gastrointestinal surgery, such as prompt postoperative gastrointestinal function recovery and reduced overall postoperative complications, which may be attributed to a reduced intestinal edema.

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Section: Discussionmentioning

confidence: 99%

“…[8,9] Because of the intestinal mucosal edema causing significant pathogenesis characterized by structural changes after injury, attention has been directed to specific care that might improve intestinal edema and intestinal transit.…”

Section: Introductionmentioning

confidence: 99%

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

et al. 2017

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“…(6, 33, 34) Systemically, the incidence of pulmonary complications, gastrointestinal dysmotility, and coagulation disturbances are higher as the volume of early crystalloid infusion is increased. Even when controlling for shock and severity of injury, the volume of crystalloid infused is associated with increased risk of developing intra-abdominal hypertension and abdominal compartment syndrome.…”

Section: Discussionmentioning

confidence: 99%

Damage Control Resuscitation Is Associated With a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients

et al. 2011

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OBJECTIVE To determine if implementation of damage control resuscitation (DCR) in patients undergoing damage control laparotomy (DCL) translates into improved survival. SUMMARY BACKGROUND DATA DCR aims at preventing coagulopathy through permissive hypotension, limiting crystalloids and delivering higher ratios of plasma and platelets. Previous work has focused only on the impact of delivering higher ratios (1:1:1). METHODS A retrospective cohort study was performed on all DCL patients admitted between 01/2004–08/2010. Patients were divided into pre-DCR implementation and DCR groups, and were excluded if they died prior to completion of the initial laparotomy. The lethal triad was defined as immediate post-operative temperature <95° F, INR>1.5, or a pH<7.30. RESULTS 390 patients underwent DCL. Of these, 282 were pre-DCR and 108 were DCR. Groups were similar in demographics, injury severity, admission vitals and laboratory values. DCR patients received less crystalloids (median 14 L vs. 5 L), RBC (13 U vs. 7 U), plasma (11 U vs. 8 U) and platelets (6 U vs. 0 U) in 24-hr; all p<0.05. DCR patients had less evidence of the lethal triad upon ICU arrival (80% vs. 46%, p<0.001). 24-hour and 30-day survival were higher with DCR (88% vs. 97%, p=0.006 and 76% vs. 86%, p=0.03). Multivariate analysis controlling for age, injury severity, and ED variables, demonstrated DCR was associated with a significant increase in 30-day survival (O.R. 2.5, 95% C.I. 1.10–5.58, p=0.028). CONCLUSION In patients undergoing DCL, implementation of DCR reduces crystalloid and blood product administration. More importantly, DCR is associated with an improvement in 30-day survival.

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“…At about this time, damage control laparotomy was first described and also began gaining widespread use. 20,21 The combination of these two treatment modalities in severely injured trauma patients resulted in the inability to close the abdominal wall due to massive intestinal and retroperitoneal edema, 26 which often persisted well after hemorrhagic shock was corrected. In 2003, Balogh et al demonstrated an association between supra-normal resuscitation and increased incidences of abdominal compartment syndrome, multiple organ failure, and mortality.…”

Section: Pharmacologic Treatment Optionsmentioning

confidence: 99%

Optimal Fluid Therapy for Traumatic Hemorrhagic Shock

Chang¹,

Holcomb²

2017

Critical Care Clinics

110

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The resuscitation of traumatic hemorrhagic shock has undergone a paradigm shift in the last 20 years with the advent of damage control resuscitation (DCR). Major principles of DCR include minimization of crystalloid, permissive hypotension, transfusion of a balanced ratio of blood products, and goal-directed correction of coagulopathy. In particular, plasma has replaced crystalloid as the primary means for volume expansion for traumatic hemorrhagic shock. Predicting which patient will require DCR by prompt and accurate activation of a massive transfusion protocol, however, remains a challenge.

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Resuscitation-Induced Intestinal Edema and Related Dysfunction: State of the Science

Cited by 57 publications

References 98 publications

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

Impact of hypertonic saline on postoperative complications for patients undergoing upper gastrointestinal surgery

Damage Control Resuscitation Is Associated With a Reduction in Resuscitation Volumes and Improvement in Survival in 390 Damage Control Laparotomy Patients

Optimal Fluid Therapy for Traumatic Hemorrhagic Shock

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